Acute coronary
Syndromes (ACS) is a term used to categorize a spectrum of diseases that
affects the heart, such as acute myocardial infarction (AMI) and unstable
angina (UA)

Pathophysiology

ACS develops
through several symptoms, and it starts with the build- up of unstable plaque.
Plaque is the most common cause of ACS. When excessive amounts of plaque build-
up it can rupture, activating the coagulation system with thrombin generation. If thrombus is partially occluded, it produces
symptoms of ischemia and if it is periodically occluded it can cause myocardial
necrosis leading to NSTEMI (Non-ST segment elevation Myocardial Infarction.
Progression to a larger clot that completely blocks the thrombus will
eventually result in STEMI (ST-segment elevation myocardial infarction).

Management Interventions

The goals of ACS
therapy are to quickly identify patients with STEMI, perform rapid
resuscitation therapy, relieve ischemic pain, prevent major adverse cardiac
events (MACE) and treat life- threatening complications (unstable tachycardia,
symptomatic bradycardia, VF/ pulseless VT). Successful and effective
interventions need to occur within the first hour symptoms began
Management
begins with recognizing patient’s chest discomfort, which can suggest ischemia.
Healthcare providers should be looking
for discomfort in the chest, which can progress to the shoulders and back,
pressure or fullness causing discomfort, and sudden shortness of breaths are
signs of ACS. Hopefully, EMS will be dispatched as quickly as possible. If they
are authorized, they should recommend that the patient chew on aspirin (if not
allergic or doesn’t have GI bleeding) as EMS team arrives.

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